Determinants of inadequate parental sun protection behaviour in their children – Results of a cross-sectional study in Germany

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Abstract

Objective

Unprotected sun exposure especially during childhood is a risk factor for skin cancer. A combined use of sun protection measures is recommended to protect children. However, the prevalence and determinants for combined use have been scarcely studied in children. The objective of this study was to identify determinants of parental sun protection behaviour.

Methods

A cross-sectional survey was performed in five regions in Bavaria (Germany) during school entrance health examination (2010/2011). Parents of 4579 children (47% female, aged 5–6 years) completed a self-administered questionnaire (response 61%).

Results

Most children were regularly protected with single measures (shade (69%), clothes (80%), hat (83%), sunscreen (89%), sunglasses (20%)). However, regarding regular and combined use, >50% of children were inadequately protected. Larger family size, lower household equivalent income, darker skin and sunburn history were associated with inadequate use of different sun protection measures. The less frequent use of one sun protection measure was associated with less frequent use of the others. Child's sex, migration background, parental education and sun exposure showed inconsistent results regarding the different sun protection outcomes.

Conclusion

Based on our results a regular, combined and correct use of multiple sun protection for children should be promoted independent of sociodemographic characteristics. Priority of shade, clothes and hat before sunscreen should be clarified.

Introduction

Ultraviolet radiation (UVR) is one of the major risk factors for skin cancer, a substantial and increasing health issue all over the world. History of sun exposure and sunburns are the most important behavioural risks (Balk, 2011, Berwick et al., 2009, Leiter and Garbe, 2008, Narayanan et al., 2010, Robinson and Rademaker, 1998). Childhood sun exposure is considered as a substantial risk because child's skin has a thinner stratum corneum, lower levels of protective melanin and a higher surface area/body-mass-ratio. Thus, protection against UVR in childhood is essential (Paller et al., 2011).

To increase the awareness of UVR hazard, to reduce hazardous exposure and to lower the long-term skin cancer incidence, general population approaches are used to promote sun protection (Berwick et al., 2009). Regardless of the skin type it is recommended to seek shade particularly during the peak-intensity midday sun and to use clothes, wide-brimmed hats and sunglasses. To protect the remaining exposed skin, sunscreen (sun protection factor (SPF) 15+) should be applied (WHO, 2003). The UV index (UVI) predicts the intensity of UVR and should be used to indicate the need for protection (Balk, 2011, Berwick et al., 2009). Previous studies found that sunscreen is the most common but often inadequately used sun protection measure in adults and children (Balk, 2011, Paller et al., 2011). According to recommendations, a combination of different measures is required to be adequately protected (WHO, 2003). Up to now, the combined use of different sun protection measures has been investigated less and studies especially targeting parents and children are scarce (Kasparian et al., 2009). Against this background, this study investigated the prevalence of combined, regular and correct application of different sun protection measures in children. The objective of this study was to identify determinants of parental sun protection behaviour.

Section snippets

Study design and study population

A cross-sectional survey was performed during school entrance health examination (2010–2011) within the framework of the health monitoring units implemented in five regions in Bavaria, Germany (Bolte et al., 2007). In four regions (Bamberg, Ingolstadt, Günzburg, Schwandorf) a complete survey of all children was conducted. In Munich, a subsample comprising all children born between October and December 2004 was selected. Parents of 4579 children (47% female) aged 5–6 years completed a

Sociodemographic characteristics

Table 1 shows phenotypic and sociodemographic characteristics of children and their families. The majority of the children had skin type II (43%) or III (44%). Most parents were married (84%) and had one (22%) or two (55%) children. A third of all children had a migration background (33%) though most children were born in Germany (97%). 43% of the parents had a high education, in most families at least one parent was employed (94%), 29% had a household equivalent income above median and 19%

Discussion

The parents in our study showed adequate behaviour regarding the use of single sun protection measures, however regular, combined and correct use of measures was inadequate for the majority of children. We found that larger families, lower household equivalent income, marginally employment/unemployment, darker skin type, sunburn history and less frequent use of other sun protection measures were significantly associated with inadequate sun protection use of at least one type. Child's sex,

Conclusion

The regular and combined use of sun protection according to recommendations of campaigns is improvable. A unique group that behaves inadequately regarding all sun protection measures cannot be defined. Certain measures used in combination were not identified; less common use of one measure was associated with inadequate protection regarding others. Our results indicate that parents with certain sociodemographic characteristics and leisure behaviour protected their child with different sun

Conflict of interest statement

The authors have no conflict of interests to disclose.

Acknowledgements

The authors thank all parents for participating in the survey and Angelika Zirngibl for excellent data management.

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    Health Monitoring Units (GME) Study Group of the 5th survey 2010/2011: Health Authority of the District Office of Bamberg (Angelika Pfister, Rosemarie Sittig, Winfried Strauch, Heidi Thamm, Anita Wunder); Health Authority of the District Office of Guenzburg (Tatjana Friess-Hesse, Dagmar Rudolph, Roland Schmid, Gudrun Winter); Health Authority of the City Ingolstadt (Isabella Bockmann, Christine Gampenrieder, Margot Motzet, Elisabeth Schneider, Traudl Tontsch, Gerlinde Woelk); Department of Health and Environment, City of Munich (Sylvia Kranebitter, Heidi Mayrhofer, Gertraud Rohrhirsch); Health Authority of the District Office of Schwandorf (Kornelia Baranek, Gitte Koch-Singer, Maximilian Kuehnel); Bavarian Health and Food Safety Authority, Munich and Oberschleissheim (Gabriele Bolte, Hermann Fromme, Lana Hendrowarsito, Caroline Herr, Joseph Kuhn, Bernhard Liebl, Uta Nennstiel-Ratzel, Manfred Wildner, Angelika Zirngibl).

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